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病案作用的发挥是靠利用来实现的,病案信息是医疗保险事业不断发展和完善的基础,保险机构根据医疗服务价格和医疗机构提供医疗服务的数量,计算医疗保险费用的支付数额。病案首页及编目(ICD-10)直接关系到医疗保障机构支付给医院的费用。利用病案提供的信息可及时、准确地为医疗保险机构反馈参保患者病案信息及住院费用情况,同时为医保患者报销住院费用提供凭据,合理使用统筹基金,减少不合理费用发生,控制医疗成本,规范医疗行为,从而可保障医疗保险机构和参保患者各自的合法权益。
Medical records play an important role in their utilization. Medical records are the basis for the continuous development and improvement of medical insurance. Insurance companies calculate the payment of medical insurance according to the prices of medical services and the amount of medical services provided by medical institutions. The medical record homepage and catalog (ICD-10) are directly related to the fees paid by the medical insurance agencies to the hospital. The information provided by the medical record can timely and accurately feed back the medical record information and hospitalization expenses of the insured patients for the medical insurance institution, provide the evidence for reimbursement of hospitalization expenses for the medical insurance patients, rationally use the overall fund, reduce the unreasonable expenses, control the medical cost, Regulate the medical behavior, so as to protect the legitimate rights and interests of medical insurance institutions and insured patients.